Sixty-three percent of U.S. hospitals treat LEP patients daily or weekly. SimulTel, Inc. ("SimulTel") is an innovative technology company founded to enhance efficiency, improve accuracy, and lower costs of interpreting in health care by facilitating the use of remote simultaneous medical interpreting ("RSMI"). Conventional medical interpreting is consecutive. The interpreting occurs after the speaker has completed speaking, necessitating that the speakers pause for the interpreter. In simultaneous interpreting, the interpreter interprets at the same time as s/he is hearing the original speech, as in the United Nations, where simultaneous voice-over interpreting is provided as delegates speak. Recently published research has shown that the use of RSMI results in significantly fewer medical errors and is faster than usual and customary interpreting methods. Patient satisfaction is also higher with RSMI. SimulTel proposes to enable health care facilities across the United States to offer RSMI to their LEP patients. This interpreting method will be made accessible by: (1) Enabling health care facilities to flexibly expand, maximize utilization of, and 'RSMI-enable'their own interpreting resources, and (2) Partnering with over-the-phone interpreting providers. During the proposed SBIR grant period, we will: (1) Determine feasibility of, and requirements for, health care facilities serving large LEP populations to RSMI-enable their interpreters through a new large- scale, multi-entity, Web-based system that can be delivered in a 'Software as a Service'model;(2) Design, develop and test the technology platform;and (3) Deploy and evaluate RSMI at participating health care facilities. The study will be conducted at three health care systems and a fourth hospital in the New York Metropolitan Area, representing a varied group of hospitals, ambulatory clinics, and nursing facilities. The health care facilities care for some of the most diverse communities in the United States, with 20-55% of their patients having limited English proficiency. Further, we will ensure that a skilled pool of interpreters, able to deliver quality interpreting, is housed on this technological innovation. To do so, we will also develop and test an online interpreter training module that will be a scalable system to efficiently train bilingual persons in RSMI. A rigorous evaluation will be conducted that examines the service, software and training program. This will include pre- and post-tests on interpreting skills and knowledge, setting up trial testbeds to extensively evaluate the system behavior and performance, reviewing system logs, quality of the service, patient satisfaction, provider satisfaction, monitoring the system and utilization statistics. SimulTel brings together a multidisciplinary team representing complementary and integrated expertise in immigrant health, linguistics and interpreting, communications technology and software development, and online education to develop, test, and disseminate a much-needed technological innovation to address the language barrier in health care.